Signs You Have a Postpartum Hernia (and What to Do About It)

When my belly button poked out immediately during my recent pregnancy, many people commented how cute it was. Sure, it was a sign my baby bump was growing, but the truth of the matter is that it also meant I had a hernia. Breezy Mama turned to OB Dr. Gafori of IGO Medical Group in La Jolla to get the scoop on how moms can tell if they have a postpartum hernia (and since the belly button doesn’t always poke out, many are unaware they even have one!), what to do about it, what can happen if you do nothing, if you can throw in a tummy tuck (ahem) with repair and more.

How does pregnancy cause a hernia?

First, we should start with a few definitions.

1. Rectus diastasis: This is an acquired condition in which the rectus muscles (the main abdominal muscles that run down the front of your belly) are separated by more than the normal 1 or 2 mm that typically separates them. This very minimal normal separation is made of fascia called the linea alba. Pregnancy and increased abdominal pressure can cause the muscle to separate and cause rectus diastasis. Women may notice a ridge in their central abdomen when they sit up or perform abdominal exercises. Sometimes, you can actually feel the defect.

2. Umbilical hernia: A hernia is the result of weakness or a defect in the fascia that surrounds the muscle. This weakness can result in the contents of the abdomen sometimes protruding out of the cavity through the defect. In the case of an umbilical hernia, the contents include intestine or omentum (abdominal fatty tissue) that is enclosed by the peritoneum( the membrane that lines the abdominal cavity). Infants can have congenital umbilical hernias which may close on their own as the child grows. However, if these hernias are large or they persist past 2 years of age they may need to be surgically corrected. Adult umbilical hernias, on the other hand, are almost always acquired and do not decrease in size on their own. They often need to be surgically corrected unless they are very small and do not cause any adverse symptoms. Pregnancy is one of the major causes of umbilical hernia in adult women. Other causes include anything that can increase intraabdominal pressure including obesity, chronic cough and ascites (fluid collection in the abdomen which may be caused by liver disease, cancer, etc.).

How can a mom tell that she has a hernia?

She may have a small soft mass protruding from the area around her umbilicus (belly button). This area may be tender with increases in pressure (coughing, lifting weights, later stages of pregnancy) or with palpation (touching). It may increase in size when she sneezes, coughs, or bares down.

What is involved in repairing it?

Hernias are repaired surgically. There are different methods that may or may not include placing mesh over the area in question. The procedure type would be determined by the general surgeon or plastic surgeon doing the repair. Most of these procedures are performed outpatient.

How long is the recovery?

The recovery depends on the severity of the defect and the actual procedure performed to repair the defect. In general, heavy lifting is restricted for the first 6 weeks after surgery.

Will moms be able to pick up their children after?

Yes, after the allotted recovery time.

What can happen if a mom does NOT get it fixed?

Many umbilical hernias are small and are difficult to notice and likely to not cause any symptoms. These do not need to be repaired. In the case of severe abdominal pain which may indicate an incarceration (where the bowel gets stuck through the hernia site) or strangulation (when the blood supply to the bowel is cut off) an emergency visit and surgery would be indicated.

Will my belly button ever go back in or only if I have surgery?

After delivery, the uterus does take time to return to its initial size. Once it does, and once the abdominal muscles are strengthened, you may notice a decrease in the protrusion of your belly button. On the other hand, hernias do not improve with exercise and weight loss.
Should I wait to lose the weight before I have surgery?

In the case of a rectus diastasis, exercises can be used to help regain some of the strength of the abdominal wall muscles. Rectus muscle plication (bringing the rectus muscles together centrally with surgery) should be performed once weight loss has occurred and typically only if there are no future plans for pregnancy. This is typically an elective procedure but can often help to improve intraabdominal tone so that it is easier to care for and lift your children. It also can help to decrease back pain that is due to poor abdominal wall tone and strength.
If you had an innie before giving birth, does a new outie generally mean you have a hernia?

Not necessarily.

Before having the surgery, is it okay to return to doing sit-ups and other exercises?

Yes, though these exercises will not improve the hernia. Abdominal exercises will strengthen the rectus muscles but will not decrease the defect in the fascia.

Are some hernias more mild than others or should all be treated?

There is no need for repair of a hernia that is small and does not cause any pain. Hernias that are large, that cause pain, or that incarcerate or trap bowel or fat in them should be surgically repaired.

If a mom is not done having children, should she wait to have surgery?

Unless the hernia is causing bothersome symptoms, repair should be delayed until childbearing is completed. In rare cases, hernias can cause problems during pregnancy that may necessitate surgery during the pregnancy. A person that has a symptomatic hernia prior to pregnancy may have worsening symptoms during pregnancy and should probably consider repair before they get pregnant.

Can doctors do a tummy tuck while repairing the hernia?

Yes, the medical term is abdominoplasty and this can be performed at the same time as a hernia repair. In most cases the abdominoplasty procedure includes plication (reattachment) of the abdominal muscles centrally so that the rectus diastasis is repaired. If a hernia is indeed present, the general surgeon or plastic surgeon can repair it at the same time.

About Dr. Gafori:Valerie Gafori MD, FACOG is a board certified obstetrician/gynecologist. She completed her undergraduate degree in Physics at MIT, her masters degree in Biology at Stanford University, and medical degree at UMDNJ: New Jersey Medical School. She completed her residency in OB/GYN at George Washington University and joined a private practice in Washington DC for one year before she moved to La Jolla. She is now in private practice in La Jolla, California with IGO Medical Group. She has special interests in minimally invasive surgery and gynecology.

Comments

I also had an umbilical hernia. It no longer hurts 3 years post baby, but I definitely still have weakened abs despite 4 to 5 days of regular strength training Bar Method classes per week. Of course I blame my “hernia” for not having wash board abs (wine and cheese have nothing to do with it), but I do have to think that this has something to do with it. Good to know about the tummy tuck 🙂

Had an umbilical and incisional hernia post-partum (c-section). Did physical therapy for a year, tried not to lift too much, etc. The small defect got worse over time to the point I had trouble walking fast, running, lifting, etc. Best choice I made to have surgery for it. Don’t wait like I did — if you hurt, have it repaired. They really don’t improve otherwise and life is too short.

Congratulations on the birth of your twins! I also got an umbilical hernia when I was preggers with my twins. I recently just got a mommy makeover..aka tummy tuck and breast augmentation to fix all the flab and sagging that occurred from having my twins. I had my hernia fixed during the surgery and at my first post-op appointment my doctor told me he sewed up a four and a half inch gap in my rectus muscles! Holy crazy!

Thank you Sevin — you have me motivated.
Kelly — Thanks for the congrats! And now you have me curious how big my gap is after twins!
Pam — lol. What will I blame for not having washboard abs after I have it done? 😉

So Sevin, how much did it all cost? what did insurance cover? from what I’ve researched its difficult to get cosmetic surgery and medical necessaity surgery together because it has to be done by two different doctors.

I also have this. After having my twins, I noticed that my belly button was still WAY out. After losing all the weight, (thank you twin breast feeding!!!) I merely thought it was from carrying them full term and measuring 52 weeks, I was okay with a little deformity (I guess). I did see a surgeon recently, and it does need to be fixed. Good information here 🙂 Thanks!

I am sure I have an umbilical hernia and a diastasis. I’m not done having children so I don’t want to get them repaired yet. However, I’m wondering if there might be something more going on with my abdomin. I’m very fit and do regular exercise and strenghth training. My ab muscles are quite strong but I have a very round, protruding belly. I still get asked if i’m expecting because I constantly look like i’m 3-5 months pregnant. If I suck in I still can’t get my belly to go flat. What kind of Dr. should I see about this? My nurse midwife didn’t think there was anyting odd. I’m on a gluten free and dairy free diet and still no change. I don’t mind looking pregnant when I’m pregnant but this is embarassing. My youngest is 19months. Thanks

I have a hernia and it makes me very nervous due to the risk of strangulation. Anyone else have this anxiety?
We want more children , and the surgery freaks me out, especially with all these surgical mesh problems.
I have never heard of this before it happened to me.
Info on the internet is SCARY!!
Any advice from someone who has been through it would be great!!
THANKS

During my pregnancy in 2008, I soon found out about an inguinal hernia in my first trimester. I had a c-section, then one year later my hernia repair surgery. Gave birth again in April 2011-another c-section and now I am having the same symptoms of that hernia again! I am also having soreness in my upper abdominal wall similar to when my stomache was all stretched out during pregnancy. I have an appt. with the same surgeon who did my first surgery in a week. Any advice? Should I seek a second opinion? Is it normal to have the same hernia appear or could the mesh be inferior?

I had my second baby 5 years ago. I am a ‘retired’ athlete who is now a weekend warrior. In the morning, I have a flatter tummy. But, my tummy “grows” during the day. By night, I am 5 months pregnant, while sucking it in.

Worse, when I do bending over moves, I get sharp pains around my belly area – from about 2 inches above the bellybutton to 2 inches below. Worst are Yoga moves like Plow. I am limber enough to get into it, but I snap out of it due to the belly pain. Any move that has me bending over, sometimes I feel like I can’t breathe. I am a figure skater, and going some moves like a Camel Spin (an arabesque while spinning) too much causes me extreme back and hip pain. I think my stomach area being weak (and hanging down) is what is causing the back pain. When I pull upright, I get small shooting pains around my belly button.

I wonder if I have a hernia. I thought it was a mummy tummy, and I’d just get through it. Skate through the pain has been drilled into me for too long.

Thank you for this article. It was helpful to me in understanding my postpartum hernia.

Fellow Mamas, I too, have a rather large diatasis and suspected umbilical hernia. I’m 12 months postpartum. I wanted to share some hope with you all that does not involve surgery! It’s helped me tremendously~~the key is CONSISTENCY with the exercises and other steps of the program.

And, if your diastasis is wide (greater than three fingers during self-test) like mine, you may benefit from wearing the awesome FITsplint I’ve linked to below. I LOVE mine. Couldn’t live without it. As stated in the below linked exercise programs though, you can’t DEPEND on the splint to heal things. You have to use it as a comfort measure WHILE doing the exercises faithfully and holding your TVA in (with correct posture) throughout the day. Hope this helps someone as it has helped me.

I recently consulted my gynocologist about pain on my lower abdomen. He performed a sonogram and saw a small tear on my abdominal muscle from my belly button down. You can see a slight indentation on my tummy and at times can be very painful when I do certain activities. I do not have any loose skin. I have had two c sections and a hysterectomy. My gynocologist says he can perform surgical procedure to close my abdominal muscle. After reading posts about having a plastic surgeon do procedure I am concerned now. Advice please

Cristy, I could have written your post. I’m almost 6 months post op. I’ve been having umbilical pain for my entire post op period that is painful to touch. I also have diastasis diagnosed about 5 months into my pregnancy but it really didn’t progress all that much as I got farther along. I can fit one finger breadth between my rectus. Whats more though, is that I still have this pregnancy pooch which makes me look like i’m 4-5 months along. I can’t suck it in and can’t wear anything fitted in fear of someone asking me when i’m due. I called my OB today because lately i’ve been experiencing sudden shooting pains in my umbilicus. We want to try for more babies so the question is; wait, get preg, and hope it doesn’t worsen or repair it and wait to have a babe. Meh..

The article is very informative thank you.After two c-section my stomach went similar to the above picture as you shown.Doctor told i have very small hernia.he told surgery is needed but not now necessary.my belly botton is paining sometime.is my case getting severe?

I had my twins by C-section almost 3 years ago. I noticed my belly button feeling very tender to the touch within the first year post partum. My OB said that I had a small umbilical hernia but that it didn’t need surgery at that time. Like many of you, my pregnancy belly has never went away. I lost all the baby weight and then gained some back, but no matter what my weight, the belly never goes away. It is very firm above my belly button, but that is the area that is the largest and I still look 4-5 months pregnant. My lower abdomen is still large, but actually sinks in down the middle. I recently was advised that I also had rectus diastasis. My separation is a 4.. That explains the large sunken in area below my belly button. I have been doing abdominal exercises to bring them closer together, but it is taking time. However, recently, I have noticed my hernia becoming more sensitive. It no longer just hurts when it is pushed inside my belly button, but there is some pain along the bottom to the right and sometimes it spreads around to the top of the navel. I don’t see that the hernia is any larger or more noticeable, but the sharp pains around my navel are getting bothersome. When the twins climb on me or jump on me, it really hurts. Anyone else have the same thing???